Vismodegib (Erivedge™)

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Facts about vismodegib

Vismodegib is a type of targeted therapy called a "Hedgehog pathway inhibitor". This means it works by targeting a pathway (series of signals or events) that drives cancer growth. Disrupting the Hedgehog signal prevents the cancer from growing.

How to take vismodegib

Vismodegib comes in a capsule form and is taken once a day. The capsule should be swallowed whole with a glass of water; do not break or open the capsule. You can take it with or without food. If you miss a dose, skip the missed dose and take your next dose at the usual time.

You should not take vismodegib at the same time as "heartburn" medications (including proton pump inhibitors such as prilosec, nexium, protonix; H2 blockers, such as tagamet, zantac; and antacids, such as Tums, Rolaids) as these may effect how vismodegib is absorbed. If needed, take these medications 2 hours before or after vismodegib.

Side effects of vismodegib

Below are some of the possible side effects and suggestions for dealing with them. Be sure to tell your oncology team if you are experiencing any of these problems.

Reproductive Concerns

Exposure of an unborn child to this medication could cause severe birth defects.

Women should have a negative pregnancy test obtained within 7 days of starting the medication and they should not become pregnant while on therapy or for 7 months after the last dose. Effective birth control is necessary during treatment, even if your menstrual cycle stops.

Men should not father a child while on this medication or for 2 months after the last dose. Men should use a condom with spermicide (even if you have had a vasectomy) to protect your partner from exposure to the medication- or yourself if your partner is taking the medication. Effective birth control is necessary during treatment, even if you believe you are sterile.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Nausea and/or Vomiting

Take anti-nausea medications if prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Loss or Thinning of Scalp and Body Hair (Alopecia)

Your hair may become thin, brittle, or may fall out. This hair loss can include all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun. Read more on alopecia.

Other Concerns

Patients should not donate blood while receiving vismodegib and for at least 7 months after stopping the medication.

In studies, some patients taking vismodegib developed muscle cramps. Let your healthcare provider know if you experience this side effect.

Jun 7, 2012 - A small-molecule inhibitor of the hedgehog pathway, vismodegib, is associated with tumor response in patients with metastatic or locally advanced basal cell carcinoma (BCC); and vismodegib is efficacious for preventing and treating BCCs in patients with basal cell nevus syndrome, according to two studies published in the June 7 issue of the New England Journal of Medicine.